Sahn S A, Lakshminarayan S
Br J Dis Chest. 1976 Jul;70(3):195-205. doi: 10.1016/0007-0971(76)90029-2.
Fourteen episodes of reactivation of tuberculosis after corticosteroid administration are reported. In most a disease impairing the host defences was present and four were taking additional immunosuppressants. The most common presenting symptoms were productive cough and malaise. Bacteriological diagnosis required bronchoscopy in three cases. Response to antituberculosis therapy was good. Five of the 14 episodes manifested dissemination of pulmonary tuberculosis with four occurring in patients receiving high-dose corticosteroids and other immunosuppressants. No prolongation of sputum conversion time was noted in the patients. The published effects of corticosteroids on the tuberculous state are reviewed. Because INH administration may cause liver damage in a small minority of patients, a reassessment is required of the need for INH chemoprophylaxis when corticosteroids are used in patients with healed tuberculosis.
本文报告了14例在使用皮质类固醇后结核病复发的病例。大多数患者存在损害宿主防御功能的疾病，4例患者正在服用其他免疫抑制剂。最常见的症状是咳痰和全身不适。3例患者的细菌学诊断需要通过支气管镜检查。抗结核治疗反应良好。14例中有5例表现为肺结核播散，其中4例发生在接受大剂量皮质类固醇和其他免疫抑制剂治疗的患者中。这些患者的痰菌转阴时间没有延长。本文回顾了皮质类固醇对结核状态的已发表影响。由于少数患者服用异烟肼可能会导致肝损伤，因此当对已治愈的结核病患者使用皮质类固醇时，需要重新评估是否需要进行异烟肼化学预防。
